{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T13:54:46Z","timestamp":1780322086315,"version":"3.54.1"},"reference-count":19,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,6,21]]},"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:p>Variations in parathyroid gland positions often cause failure in initial parathyroid adenoma surgery, especially when imaging fails to localise the adenoma. This report describes a female patient with primary hyperparathyroidism for which preoperative localisation studies did not determine the position of the hyperfunctioning gland. The initial approach with bilateral cervical exploration and intraoperative parathyroid hormone monitoring was performed unsuccessfully. A mediastinal adenoma was suspected due to meticulous negative neck exploration and repeated negative images for a neck adenoma. Subsequently, a second approach involving mediastinal exploration was performed. After the removal of remnant thymic tissue in the mediastinal space, a significant drop in intraoperative parathyroid hormone levels was achieved. The pathological result confirmed the presence of a tiny pathological parathyroid adenoma within the thymus. At 6\u2009months follow-up, postoperative biochemical assessment was consistent with normal calcium and parathyroid hormone levels.<\/jats:p>","DOI":"10.1136\/bcr-2023-258728","type":"journal-article","created":{"date-parts":[[2024,7,4]],"date-time":"2024-07-04T13:40:13Z","timestamp":1720100413000},"page":"e258728","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Primary hyperparathyroidism caused by a tiny mediastinal parathyroid adenoma with non-localising imaging studies"],"prefix":"10.1136","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5132-1793","authenticated-orcid":false,"given":"Pedro Polastri Lima","family":"Peixoto","sequence":"first","affiliation":[{"name":"Department of Ophtalmology, Otolaryngology, Head and Neck Surgery, University of Sao Paulo Faculty of Medicine of Ribeirao Preto, Ribeirao Preto, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniella de Freitas Pereira Calheir","family":"Dur\u00e7o","sequence":"additional","affiliation":[{"name":"Department of Pathology and Forensic Medicine, University of Sao Paulo Clinics Hospital of the Faculty of Medicine of Ribeirao Preto, Ribeirao Preto, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luiz Carlos","family":"Conti de Freitas","sequence":"additional","affiliation":[{"name":"Department of Ophtalmology, Otolaryngology, Head and Neck Surgery, University of Sao Paulo Faculty of Medicine of Ribeirao Preto, Ribeirao Preto, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,7,4]]},"reference":[{"key":"2025082709021480000_17.7.e258728.1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000000812"},{"key":"2025082709021480000_17.7.e258728.2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-007-9068-5"},{"key":"2025082709021480000_17.7.e258728.3","doi-asserted-by":"publisher","DOI":"10.1007\/s00423-012-1004-y"},{"key":"2025082709021480000_17.7.e258728.4","doi-asserted-by":"crossref","first-page":"744","DOI":"10.3803\/EnM.2022.1589","article-title":"Update on preoperative parathyroid localization in primary hyperparathyroidism","volume":"37","author":"Park","year":"2022","journal-title":"Endocrinol Metab (Seoul)"},{"key":"2025082709021480000_17.7.e258728.5","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1001\/jamasurg.2016.2310","article-title":"The American Association of endocrine Surgeons guidelines for definitive management of primary hyperparathyroidism","volume":"151","author":"Wilhelm","year":"2016","journal-title":"JAMA Surg"},{"key":"2025082709021480000_17.7.e258728.6","first-page":"111","article-title":"The relationship of negative imaging result and surgical success rate in primary hyperparathyroidism","volume":"57","author":"Unlu","year":"2023","journal-title":"Sisli Etfal Hastan Tip Bul"},{"key":"2025082709021480000_17.7.e258728.7","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-010-1429-x"},{"key":"2025082709021480000_17.7.e258728.8","doi-asserted-by":"crossref","DOI":"10.1177\/20406223211015965","article-title":"Advances in the diagnosis and the management of primary hyperparathyroidism","volume":"12","author":"Islam","year":"2021","journal-title":"Ther Adv Chronic Dis"},{"key":"2025082709021480000_17.7.e258728.9","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1016\/j.jamcollsurg.2015.01.004","article-title":"Real-time super selective venous sampling in remedial parathyroid surgery","volume":"220","author":"Lebastchi","year":"2015","journal-title":"J Am Coll Surg"},{"key":"2025082709021480000_17.7.e258728.10","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1007\/s00104-014-2820-0","article-title":"Intraoperative management of undetectable parathyroid adenoma","volume":"86","author":"Dotzenrath","year":"2015","journal-title":"Chirurg"},{"key":"2025082709021480000_17.7.e258728.11","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1046\/j.1365-2168.1999.01124.x","article-title":"Clinical dilemma: A parathyroid adenoma cannot be found during neck exploration of a patient with presumed primary hyperparathyroidism. How should this problem be tackled","volume":"86","author":"Rothmund","year":"1999","journal-title":"Br J Surg"},{"key":"2025082709021480000_17.7.e258728.12","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1177\/000313481908500932","article-title":"Multimodal preoperative localization improves outcomes in Reoperative Parathyroidectomy: A 25-year surgical experience","volume":"85","author":"Patel","year":"2019","journal-title":"Am Surg"},{"key":"2025082709021480000_17.7.e258728.13","first-page":"55","article-title":"Primary hyperparathyroidism due to Mediastinal parathyroid lesions","volume":"18","author":"Gawrychowski","year":"2021","journal-title":"Kardiochir Torakochirurgia Pol"},{"key":"2025082709021480000_17.7.e258728.14","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2014-1267"},{"key":"2025082709021480000_17.7.e258728.15","doi-asserted-by":"crossref","unstructured":"Kim AW , Detterbeck FC . Surgical approaches to Mediastinal parathyroid glands. 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